Associations between childhood adverse experiences and medication adherence in asthma patients: a dual...

Childhood adverse experiences are increasingly recognized as risk factors for poor health outcomes in chronic diseases. However, their influence on medication adherence in asthma patients remains underexplored, with limited research addressing the key psychological constructs of attachment security and mentalization. This study adopts both variable-centered and person-centered perspectives to investigate the association between childhood adverse experiences and medication adherence among asthma patients, as well as the heterogeneity within this relationship.

A cross-sectional design with convenience sampling was employed. From July to August 2025, 525 asthma patients were recruited from four tertiary hospitals in Beijing, China. Participants completed validated scales measuring childhood adverse experiences, attachment security, mentalization, medication adherence, and relevant demographic information. Structural equation modeling was used to examine the indirect statistical associations of attachment security and mentalization. Latent profile analysis identified subgroups based on attachment security and mentalization profiles.

Findings demonstrated a significant negative correlation between childhood adverse experiences and medication adherence in asthma patients. From the variable-centered perspective, higher levels of childhood adverse experiences were associated with lower attachment security, which was in turn associated with lower mentalization capacity; this sequence showed a significant indirect association with medication adherence. The person-centered analysis revealed three latent profiles characterized by "high attachment security-high mentalization,"(7.6%) "moderate attachment security-moderate mentalization,"(83.9%) and "low attachment security-low mentalization."(8.5%).

This study identified significant direct and indirect statistical associations among childhood adverse experiences, attachment security, mentalization, and medication adherence among asthma patients. Attachment security and mentalization statistically mediated the relationship between childhood adverse experiences and medication adherence within a theoretically specified model. A person-centered approach revealed heterogeneous subgroups, underscoring the need for tailored interventions. Clinically, integrating trauma-informed psychological screening may enhance adherence and improve asthma management outcomes.